Luela L.

Aniceto BSN- 1C
Health Assessment (April 29, 2016)
Questions:
Health Perception- Health
Management Pattern
1. Do you have allergies? If so? What
were they?
2. What kind of allergic reactions do

Allergies
Side effects/ reaction of the allergies

you get? Is it itching? Runny nose?

Rashes? Or what other side effects
do you feel?
3. Do you have blood transfusion

Blood transfusion

before?
4. In your own understanding how do

Definition of health and illness

you define health? How about

illness?
5. How many sticks of cigar do you
smoke every day?
Nutritional- Metabolic patterns
6. Do you put seasonings on your

Number of cigarette smoked per day

Condiments on food

food? Like, vinegar, soy sauce,

ketchup, salt and others?
7. How often do you drink soft

Carbonated beverages

drinks?
8. Can you describe your appetite? Is

Describing appetite

it good, fair, or poor?

9. Who usually cooks your food at

Preparing and cooking food at home

home?
10.How often do you eat fast food
Elimination Pattern
11.How many times do defecate

Eating fast food

Defecation

every day?
12.What is the usual color of your

Color of stool

stool?
13.Have you experienced having

Constipation

constipation before?
14.How many times do you void

Urination

every day?
15.Can you estimate how many glass

Estimation of the amount of urine

of urine you have eliminated per

day?
Activity- Exercise Pattern
16.Can you share to me your daily

eliminated

Every day routine

routine from the time you wake up

to the time you go to sleep?
17.How will you describe your

Describing weekend activities

weekend activities?
18.What are your hobbies? Or what

Hobbies/ activities

activities do you engage with

during your free time?
19.Have you tried giving up an

How health affects activities

activity or a hobby because of

some physical health condition?
20.Does your illness affects your

Effect of illness in performance

performance in such activities that

you like?
Sleep- Rest Pattern
21.What time of the night do you

Sleeping time

usually sleep?
22.What time of the day do you

Time to wake-up

wake-up?
23.Have you tried counting your

Hours of sleep

sleep in hours during the night? If

so, then how many hours do you
get?
24.Do you have troubles in sleeping?
25.What do you usually feel upon

Troubles in sleeping
Describing feelings after sleep

waking up? Do you feel, rested?

Tired?
Cognitive- Perceptual Pattern
26.What other language do you

Language spoken

speak?
27.Do you wear glasses or contact

Vision aids

lenses?
28.How many times do you clean

Cleaning ears

your ear in a week?

Sexuality- Reproductive Pattern
29.What is your age during your first
menstruation?
30.How many weeks is the fetus
inside your womb when you start
your labor?

Age of Menarche
Weeks of AOG at time of labor